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Evaluation of hemodynamically significant pericardial effusion by analysis of cardiac chambers volume by computed tomography

OBJECTIVE: Pericardial effusion may present clinically as pleuritic chest pain, dyspnea, or hemodynamic compromise and is a frequent finding in computerized tomographic pulmonary angiography (CTPA) exams. We hypothesized that CTPA-based analysis of the cardiac chamber volumes can be used to predict...

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Detalles Bibliográficos
Autores principales: Granot, Yoav, Rozenbaum, Zach, Yashar, Hila, Shalmon, Tamar, Berliner, Shlomo, Aviram, Galit
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The British Institute of Radiology. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9733607/
https://www.ncbi.nlm.nih.gov/pubmed/36169378
http://dx.doi.org/10.1259/bjr.20220106
Descripción
Sumario:OBJECTIVE: Pericardial effusion may present clinically as pleuritic chest pain, dyspnea, or hemodynamic compromise and is a frequent finding in computerized tomographic pulmonary angiography (CTPA) exams. We hypothesized that CTPA-based analysis of the cardiac chamber volumes can be used to predict the hemodynamic significance of pericardial effusion (HsPE) as compared with echocardiography. METHODS: Retrospective analysis of consecutive patients who underwent CTPA and echocardiography between January 2009 and November 2017 that ruled-out acute pulmonary embolism was included. Differences in cardiac chamber volumes were investigated in correlation to echocardiographic evidence of HsPE. RESULTS: The final cohort included 208 patients, of whom 22 (11%) were diagnosed with HsPE. The HsPE patients had much smaller right cardiac chamber volumes (Median 78.8 ml (IQR 72.4–89.1)) than patients without HsPE (Median 115.1 ml (IQR 87.4–150). A decision tree for the prediction of HsPE showed multiple cutoff values. Right atrium (RA) volume had the best accuracy (area under the curve 0.851, 95% confidence interval 0.776–0.925, p < .001) for predicting the presence of HsPE. An RA volume ≤86 ml yielded a sensitivity of 95.5%, a specificity of 64%, and a NPV of 99.2% for the presence of HsPE. CONCLUSION: CTPA-based volumetric information with focus on the RA volume may help predict the presence of HsPE. ADVANCES IN KNOWLEDGE: Pericardial effusion is a frequent finding in CTPA exams. Our study shows that CTPA-based volumetric information can predict the presence of HsPE with RA volume as the best indicator.